Complications of suppurative otitis media - PowerPoint PPT Presentation

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Complications of suppurative otitis media
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Complications of suppurative otitis media

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  1. Complications of suppurativeotitis media

  2. Factors influencing development of complications • Age • Poor socio-economic group • Virulence of organisms • Immune-compromised host • Preformed pathways • Cholesteatoma

  3. Pathways of spread of Infection • Direct Bone Erosion • Venous Thrombophlebitis • Performed pathways

  4. Classification • Intratemporal(confines within the temporal bone): • Mastoiditis • Petrositis • Facial paralysis • Labyrinthitis

  5. B)Intracranial: • Extradural abscess. • Subdural abscess • Meninigitis • Brain abscess • Lateral sinus Thrombophlebitis • Otitic Hydrocephalus

  6. 1)Acute mastoiditis When the infection spreads from mucosal lining to bony wall of mastoid air cells we called it as mastoiditis. Aetiology: It usually accompanies or follows ASOM.The determining factors being high virulence of organisms or lowered resistance of patient.

  7. Pathology: 1)Production of pus under tension. 2)Hyperaemic decalcification and osteoclastic resorption of bony walls.

  8. Clinical Features: Symptoms: • Pain behind the ear. • Fever. • Ear discharge

  9. Signs: • Mastoid Tenderness. • Ear Discharge • Sagging of postero-superior meatal wall • Perforation of tympanic membrane • Swelling over the mastoid • Hearing loss. • General findings

  10. Investigations: • Blood counts • ESR • X-ray mastoid • Ear swab

  11. Treatment: • Hospitalisation of patient • Antibiotics • Myringotomy • Cortical Mastoidectomy. It is indicated when there is • Sub-periosteal abscess. • Sagging of postero-superior meatal wall. • Positive resorvoir sign. • No response within 48 hrs of adequate medical treatment. • Mastoiditis leading to complications

  12. 2)Petrositis Spread of infection from middle ear and mastoid to petrous part of temporal bone is called petrositis. Clinical features: • Gradenigo’s syndrome : It is the classical presentation , and consist of a triad of a)external rectus palsy b)deep seated ear or retro orbital pain c)persistent ear discharge. • Fever , headache , vomiting , neck rigidity,facial paralysis.

  13. Treatment: • Cortical , modified or radical mastoidectomy is often required. • Iv antibiotics should precede and follow surgical intervention.

  14. 3)Labyrinthitis: There are three types of labyrinthitis: a)Circumscribed labyrinthitis b)Diffuse serous labyrinthitis c)Diffuse suppurativelabyrinthitis

  15. A)Circumscribed labyrinthitis(Fistula of labyrinth): There is thining or erosion of bony capsule of labyrinth. Aetiology: • CSOM with cholesteatoma • Neoplasms of middle ear • Surgical or accidental trauma to labyrinth

  16. Clinical features: A part of membranous labyrinth is exposed and becomes sensitive to pressure changes . so complain of: • Triensient vertigo often induced by pressure on tragus, cleaning the ear or while performing valsalva manoeuvre. • Diagnose by fistula test. Treatment: a)Mastoid exploration. b)Systemic antibiotics.

  17. B)Diffuse serous labyrinthitis It is diffuse intra-labyrinthine inflammation without pus formation and is a reversible condition if treated early. Aetiology: • Pre-existing circumscribed labyrinthitis associated with chronic middle ear suppuration or cholesteatoma. • In acute infections inflammation spreads through round window.

  18. Clinical features: In mild cases-vertigo and nausea. In severe cases-vertigo is worse with marked nausea , vomiting and even spontaneous nystagmus. Chochlea is also affected with some degree of SNHL. Total loss of vestibular and cochlear function.

  19. Treatment: Medical- • Bed rest • Antibacterial Therapy • Labyrinthine sedatives-prochlorperazine(stemetil) • Myringotomy if labyrinthitis has followed ASOM and drum is bulging. • Surgical: mastoidectomy

  20. Diffuse suppurativelabyrinthitis: This is diffuse pyogenic infection of labyrinth with permanent loss of vestibular and cochlear functions. Aetiology: It usually follows serous labyrinthitis, pyogenic organisms entering through a fistula.

  21. Clinical Features: • There is severe vertigo, nausea, and vomiting due to acute vestibular failure. • Spontaneous nystagmus. • Patient looks toxic with total loss of hearing. Treatment:

  22. B)Intracranial complications : Otogenic brain abscess: 50% of brain abscess in adults and 25%in children are otogenic .Cerebral abscess is seen twice as frequently as cerebellar abscess. Routes of infection: They develops as a result of direct extension of middle ear infection through tegmen or by thrombophlebitis.

  23. Pathology: a)Stage of invasion(initial encephalitis) b)Stage of localisation(latent abscess) c)Stage of enlargement(manifest abscess) d)Stage of termination(rupture of abscess)

  24. Clinical Features: Brain abscess is often associated with other complications. It can be divided into: a)Those due to raised ICP b)Those due to area of brain affected

  25. a)Symptoms and sign of raised ICP • Headache • Nausea and vomiting • Level of consciousness • Papiloedema • Slow pulse and subnormal temp.

  26. b)Localising Features: Temporal lobe abscess: • Nominal Aphasia • Homonymous hemianopia • Contralateral motor paralysis • Epeliptic fits

  27. Investigations: a)Skull x-rays including mastoids b)CT scan c) LP Treatment: • High dose of iv antibiotics. • For raised ICP-Dexamethasone 4mg iv 6 hrly • Discharge from ear is treated by suction clearance and topical ear drops. • Neurosurgical treatment.

  28. LATERAL SINUS THROMBOPHELEBITIS • ETIOLOGY: • COMPLICATION OF ACUTE COALESCENT MASTOIDITIS,MASKED MASTOIDITIS OR CHRONIC SUPPURATION OF MIDDLE EAR AND CHOLESTEATOMA • CLINICAL FEATURE • HETIC TYPE OF FEVER WITH RIGOR • HEADACHE • PROGRESSIVE ANAEMIA &EMACIATION • PAPILLOEDEMA

  29. TRETMENT • SYSTEMIC ANTIBACTERIAL • MASTOIDECTOMY & EXPOSURE OF SINUS • LIGATION OF INTERNAL JUGULAR VEIN • ANTICOAGULANT THERAPY • SUPPORTIVE TRETMENT